Is Mental Stress-Induced Myocardial Ischemia (MSIMI) Associated with Adverse Cardiovascular Events in Patients with Coronary Heart Disease?

Coronary heart disease (CHD) is the leading cause of death around the world. According to recent studies, about 30% to 60% of patients with Coronary Artery Disease could present with myocardial ischemia induced by mental stress.

Numerous studies have found that mental stress-induced myocardial ischemia (MSIMI) is frequent in patients with coronary artery disease and is associated with worse prognosis. Young women with a previous myocardial infarction (MI), is a group with unexplained higher mortality than men of comparable age. They have shown elevated rates of mental stress-induced myocardial ischemia (MSIMI, but the mechanisms are unknown. This blog analyses the factors leading to the mental stress-induced myocardial ischemia (MSIMI) and methods to diagnose the condition.

Factors Associated with MSIMI

Mental stress-induced myocardial ischemia (MSIMI) is associated with the following factors:

• Inflammatory response
• Hyper activation of the sympathetic nervous system
• Increased catecholamines
• Anger
• Diagnosis of depression
• Anxiety

Studies on the Relationship between MSIM and Adverse Outcome in Patients

Some of the recent studies have shown that MSIMI is closely associated with adverse cardiac events in patients with CAD.

A recent research on the relationship between mental stress-induced left ventricular dysfunction and adverse outcome in patients with ischemia heart disease, elucidated that the reduction of left ventricular ejection fraction induced by mental stress could predict the increased risk of adverse cardiac outcomes.

In another study, myocardial annular velocity changes during mental stress were proved to be predictors of adverse cardiovascular outcomes; moreover, the greater decrease of diastolic early (e′) and diastolic late (a′) was associated with the higher possibility of major adverse cardiac events. Therefore, it is of vital importance to identify patients with CAD susceptible to MSIMI.

In a recent study, the researchers have not found any difference in vascular severity between the MSIMI negative group and the positive group in patients with CAD. Other studies have concluded that there is more obvious elevation of DBP during mental stress when compared to SBP. On the contrary, higher levels of SBP were associated with MSIMI and increased risk of MSIMI. The possible reason may be related to the age and disease history and coronary artery calcium of patients. Further research is needed to clarify this point.

Diagnosing Methods of Mental Stress-Induced Myocardial Ischemia (MSIMI)

Until recently, MSIMI could be diagnosed via echocardiography or electrocardiography (ECG), sestamibi single-photon emission computed tomography (SPECT) imaging, or peripheral arterial tonometry technique.

Technologic advances have introduced ECG, echocardiography, SPECT in detecting myocardial ischemia and standard criteria of MSIMI diagnosis have been used.

However, researchers could not draw any significant relationship between coronary artery stenosis and MSIMI. Furthermore, due to the important and evolving role of biomarkers, some researchers have focused on the association between biomarkers and MSIMI previously.

Regarding the convenience and important role of biomarkers (cardiac troponin I [cTnI], C- reactive protein [CRP] and blood pressure in cardiovascular diseases and MSIMI, they aimed to determine whether biomarkers and blood pressure could be potential predictors of MSIMI in this study.

Cardiac troponins are currently the most sensitive and specific biochemical markers used for myocardial infarction. There are three types of troponins including, troponin-C, -I, and -T. The clinical measurement of serum hs-cTnI has become an important tool in the diagnosis of acute myocardial infarction.